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DSH330059GW MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
School Health Program MS 147 - Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059GW
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/2/2021
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Montefiore Medical Center
Ruth Cassidy, Vice President and Chief Pharmacy Officer
(718) 920-7887
Primary Contact
Montefiore Medical Center
Jessica Davidow, Assistant Director
(914) 904-4468
Addresses
Street Address
1600 Webster Avenue
Bronx, NY 10457
Billing Address
Montefiore Medical Center
111 East 210th Street
Bronx, NY 10467
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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